Is the "80 hour work week" for medical residents really true or just a rumor?

[Ismet]

I still don't think 80+ hour weeks (or 100+ hour weeks as the old school residents did it) is healthy. Why can't residents work less hours and other attending physicians and residents take up the rest of the hours? I don't find this line of reasoning to be very logical. It's like going up to someone who works at a 24/7 IHOP and telling them "hey you, you better start working hundred hours a week because who will work here when you're not here?" The person's reply "anyone else who's trained to work here"
If there's not enough money to pay additional residents and attending physicians, then simply don't provide the medical care. Let patients not receive care and the resulting public outcry will force the government to give more money towards residency training programs.

This is so naive that I cringed.

1) you are comparing a waiter at IHOP to a resident physician. That's not even apples and oranges, that's apples and bears. I'm assuming you have not experienced a full day on an inpatient team, but what has been said about the dangers of handoffs is completely true. There are not enough residents to provide 3 full coverage shifts. There is no danger to anyone when there's a change in shift at IHOP. They can hire a bunch of 17 year olds to do that job and train them in a day. You're comparing that to being directly responsible for a person's health and life, something that takes years of training and of which there is a limited pool of people who are qualified to do so.

2) are you seriously suggesting to withhold medical care? Congrats, you just violated at least two of the basic ethical principles of healthcare. Sure, let's let some patients die so that I can get 9 hours of sleep.

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[Mr.Happy]

This is so naive that I cringed.

1) you are comparing a waiter at IHOP to a resident physician. That's not even apples and oranges, that's apples and bears. I'm assuming you have not experienced a full day on an inpatient team, but what has been said about the dangers of handoffs is completely true. There are not enough residents to provide 3 full coverage shifts. There is no danger to anyone when there's a change in shift at IHOP. They can hire a bunch of 17 year olds to do that job and train them in a day. You're comparing that to being directly responsible for a person's health and life, something that takes years of training and of which there is a limited pool of people who are qualified to do so.

2) are you seriously suggesting to withhold medical care? Congrats, you just violated at least two of the basic ethical principles of healthcare. Sure, let's let some patients die so that I can get 9 hours of sleep.

1. I understand the dangers of handoffs but I also think there is an equal danger in overworking residents. Even apart from the physical and mental fatigue of working 13 hour shifts six days in a row or doing 24 hour shifts regularly, what about the detrimental effect on the resident's personal life? If someone works 80+ hours a week (could be even 100+ hours per week since residents sometimes lie about the number of hours worked so that they can "pull their weight" and not look bad among their fellow residents) then will they even get some much needed time off? It looks like whatever off time they get is just used to catch up on sleep. That's not healthy. Residents need to invest time and energy on their relationships as well. They need to go do something fun as well like go watch a movie, play sports etc. This refreshes their mind and makes them healthier happier people.

Regardless of whether it's a IHOP worker or medical resident, the truth remain that the goal of both jobs is to meet a need. If there's not enough medical residents, then the medical community has to work together to increase the number of residents by working with the government and medical schools. I just don't think it's acceptable that a resident has to work 80 hours a week and then spend an additional 20-30 hours a week reading, studying, and preparing for presentations. This is very unhealthy.

2. I'm suggesting sending a petition to lawmakers that unless they increase residency training funds, there won't be enough residents to meet patient care needs since residents refuse to work inhumane hours any longer.

I'm not saying residents have to work 9 to 5 and no more. However, I think it's reasonable that residents shouldn't have to work more than 60 hours per week and that time should be inclusive of reading/studying.

 

[DermViser]

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Also, why should patients' interests be considered alone? What's humane for residents and enables them to best learn, develop competent practice habits, and maintain their health (in all forms)?

Why do you think medical education or residency training gives a **** what your needs are? How in anyway does that change that patients need to be seen, admitted, consulted on, treated and discharged? Why should patient's interests be considered alone? Bc they bring in money for the hospital, that's why.

 

[Mr.Happy]

Why do you think medical education or residency training gives a **** what your needs are? How in anyway does that change that patients need to be seen, admitted, consulted on, treated and discharged? Why should patient's interests be considered alone? Bc they bring in money for the hospital, that's why.

That's the problem. Medical education and residency training do need to care about the health and happiness of their residents. If patients need to be seen, then hire more attending physicians and mid-levels or work with legislation to increase the number of residents. Don't tell the poor resident to work 80+ hours per week and then tell him/her to do an additional 30 hours per week of reading/studying on their "own" time". Ridiculous!

 

[NickNaylor]

1. I understand the dangers of handoffs but I also think there is an equal danger in overworking residents. Even apart from the physical and mental fatigue of working 13 hour shifts six days in a row or doing 24 hour shifts regularly, what about the detrimental effect on the resident's personal life? If someone works 80+ hours a week (could be even 100+ hours per week since residents sometimes lie about the number of hours worked so that they can "pull their weight" and not look bad among their fellow residents) then will they even get some much needed time off? It looks like whatever off time they get is just used to catch up on sleep. That's not healthy. Residents need to invest time and energy on their relationships as well. They need to go do something fun as well like go watch a movie, play sports etc. This refreshes their mind and makes them healthier happier people.

Regardless of whether it's a IHOP worker or medical resident, the truth remain that the goal of both jobs is to meet a need. If there's not enough medical residents, then the medical community has to work together to increase the number of residents by working with the government and medical schools. I just don't think it's acceptable that a resident has to work 80 hours a week and then spend an additional 20-30 hours a week reading, studying, and preparing for presentations. This is very unhealthy.

2. I'm suggesting sending a petition to lawmakers that unless they increase residency training funds, there won't be enough residents to meet patient care needs since residents refuse to work inhumane hours any longer.

I'm not saying residents have to work 9 to 5 and no more. However, I think it's reasonable that residents shouldn't have to work more than 60 hours per week and that time should be inclusive of reading/studying.

Then perhaps medicine isn't for you, end of story. You have to learn. You learn by seeing patients and being in the hospital. You prepare for that learning by reading and studying. You seem to think learning can just happen magically without time investment. You would be wrong.

 

[DermViser]

That's the problem. Medical education and residency training do need to care about the health and happiness of their residents. If patients need to be seen, then hire more attending physicians and mid-levels or work with legislation to increase the number of residents. Don't tell the poor resident to work 80+ hours per week and then tell him/her to do an additional 30 hours per week of reading/studying on their "own" time". Ridiculous!

Your SDN handle is quite indicative of your complete naivete on the matter. You can't just hire more attendings or midlevels out of thin air. You can just say poof and get more residents. Your solution is more physician centric than patient centric.

I'll say this to you as your status is currently "Pre-Medical" and you have the chance to make a detour. If lifestyle is of utmost importance to you - then your best bet in playing the odds is to go into Dentistry, where you are assured a more lifestyle friendly type of practice. There are very few specialties in Medicine in which this is a possibility many of which won't happen until after residency training.

 

[Mr.Happy]

Then perhaps medicine isn't for you, end of story. You have to learn. You learn by seeing patients and being in the hospital. You prepare for that learning by reading and studying. You seem to think learning can just happen magically without time investment. You would be wrong.

I don't "seem to think" anything. I said I'm willing to to undergo a longer residency training period so that I can have more reasonable work hours.

 

[DermViser]

I don't "seem to think" anything. I said I'm willing to to undergo a longer residency training period so that I can have more reasonable work hours.

And what we are telling you is that you DON'T have that option, save for few specialties. Period.

 

[Ace Khalifa]

1. I understand the dangers of handoffs but I also think there is an equal danger in overworking residents. Even apart from the physical and mental fatigue of working 13 hour shifts six days in a row or doing 24 hour shifts regularly, what about the detrimental effect on the resident's personal life? If someone works 80+ hours a week (could be even 100+ hours per week since residents sometimes lie about the number of hours worked so that they can "pull their weight" and not look bad among their fellow residents) then will they even get some much needed time off? It looks like whatever off time they get is just used to catch up on sleep. That's not healthy. Residents need to invest time and energy on their relationships as well. They need to go do something fun as well like go watch a movie, play sports etc. This refreshes their mind and makes them healthier happier people.

Regardless of whether it's a IHOP worker or medical resident, the truth remain that the goal of both jobs is to meet a need. If there's not enough medical residents, then the medical community has to work together to increase the number of residents by working with the government and medical schools. I just don't think it's acceptable that a resident has to work 80 hours a week and then spend an additional 20-30 hours a week reading, studying, and preparing for presentations. This is very unhealthy.

2. I'm suggesting sending a petition to lawmakers that unless they increase residency training funds, there won't be enough residents to meet patient care needs since residents refuse to work inhumane hours any longer.

I'm not saying residents have to work 9 to 5 and no more. However, I think it's reasonable that residents shouldn't have to work more than 60 hours per week and that time should be inclusive of reading/studying.

No, just stop. You're just coming off as not only incredibly naive but also incredibly lazy. I'm just a premed like yourself, but even I know that the restrictions are more of a hinderance than anything. When you commit yourself to the field of medicine, then that means you should give up as much of your waking hours to medicine as humanly possible. I would not mind working more than 80 hours a week if it truly helped me become a better physician in the end. Also, no one wants to increase the number of years of residency just to have fewer hours worked per week. I don't know about you, but I don't want to be a resident for most of my life, which is what your suggested "decrease hours below 80, increase years of residency" bullcrap implies.

If you think your free time is way more important than actually being in the hospital and spending those long hours learning the skills needed to be a practicing physician, then maybe you should not pursue medicine.

To all MS3's, residents, and attendings, I appreciate all the insight y'all have given in this thread. I apologize if my post is too naive as well.

 

[Mr.Happy]

Your SDN handle is quite indicative of your complete naivete on the matter. You can't just hire more attendings or midlevels out of thin air. You can just say poof and get more residents. Your solution is more physician centric than patient centric.

I'll say this to you as your status is currently "Pre-Medical" and you have the chance to make a detour. If lifestyle is of utmost importance to you - then your best bet in playing the odds is to go into Dentistry, where you are assured a more lifestyle friendly type of practice. There are very few specialties in Medicine in which this is a possibility many of which won't happen until after residency training.

Thank you. Fair point. I know the reality on the ground can be very different from the ideals in my mind. I just think it's ridiculous that one has to work 80+ hours a week (more maybe so that fellow residents see you are "pulling your weight") and then do an additional 30 hours of reading/studying/preparing for presentations on my "own time". Looks like residents just sleep and work, nothing else.

 

[Ace Khalifa]

Thank you. Fair point. I know the reality on the ground can be very different from the ideals in my mind. I just think it's ridiculous that one has to work 80+ hours a week (more maybe so that fellow residents see you are "pulling your weight") and then do an additional 30 hours of reading/studying/preparing for presentations on my "own time". Looks like residents just sleep and work, nothing else.

If that's what it takes, then so be it.

 

[KnuxNole]

Honestly, if I've been up past like 20 hours without sleep, I doze off easily and would need a 3rd or 4th caffeine drink to function. I remember I almost blew off a few nursing calls since I was too sleepy to remember what diseases they had....

 

[Mr.Happy]

No, just stop. You're just coming off as not only incredibly naive but also incredibly lazy. I'm just a premed like yourself, but even I know that the restrictions are more of a hinderance than anything. When you commit yourself to the field of medicine, then that means you should give up as much of your waking hours to medicine as humanly possible. I would not mind working more than 80 hours a week if it truly helped me become a better physician in the end. Also, no one wants to increase the number of years of residency just to have fewer hours worked per week. I don't know about you, but I don't want to be a resident for most of my life, which is what your suggested "decrease hours below 80, increase years of residency" bullcrap implies.

If you think your free time is way more important than actually being in the hospital and spending those long hours learning the skills needed to be a practicing physician, then maybe you should not pursue medicine.

To all MS3's, residents, and attendings, I appreciate all the insight y'all have given in this thread. I apologize if my post is too naive as well.

I guess if you don't want to work 80+ hours per week and then do an additional 30 hours per week of reading/studying/preparing for presentations in your "own time", then you are "incredibly lazy"?

Also, no one is saying you have to extend your years of residency. I'm saying residents should have the option to extend their residency if they choose to.

I never said my free time is "way more important" than actually being in the hospital so don't put words in my mouth. I just want more of a balance. I would still happily devote the majority of my time in the hospital and reading/studying but I'd like to do more than sleep in my free time. Not too much to ask.

Look, I disagree with your opinion just like you disagree with mine but unlike you, I'm not going to insult you and call you "incredibly lazy" and say you should not practice medicine. I have an opinion and I'm voicing it.

 

[Mr.Happy]

Honestly, if I've been up past like 20 hours without sleep, I doze off easily and would need a 3rd or 4th caffeine drink to function. I remember I almost blew off a few nursing calls since I was too sleepy to remember what diseases they had....

You prove my point.

 

[SouthernSurgeon]

So what's worse for patients, residents falling asleep and functionally drunk from sleep deprivation treating them or more handoffs between residents who are in appropriate shape to treat them?

Gross misapplication of a single poor quality study

To be honest I'd rather do my 80 hours with a few 30-hr shifts rather than a bunch of 16s.

Ding ding ding we have a winner!

14-16 hr shifts 6 days in a row are much more miserable than Q4 24-30hr call with post-call days.

Are we stuck with this change now? Is there an effort to have it reversed or is the status quo cemented at this point? It has only been about a decade or so.

Zero chance that the 80 hour cap is going anywhere.

Nor, honestly, should it. Overall the cap on hours is a good thing because there has to be SOME limit...and the equivalent of 2 full time jobs is probably pushing it. The problem with the 80 hrs is the enforcement - if it is too stringent on a day-to-day or week to week basis (i.e. 16 hr shift cap, 8 hr break rule, 1 off in 7 each week rather than averaged over 4 weeks) it impinges on educational opportunities (i.e. I can't stay after my shift ends to see a talk I really want to see, or I can't stay to see an extremely rare operation). But there has to be some limit for quality of life.

There is some current goings-on that may shift the rules back a little bit and allow for greater flexibility in their application. But I won't believe they are actually going to happen until I see it.

 

[DermViser]

Thank you. Fair point. I know the reality on the ground can be very different from the ideals in my mind. I just think it's ridiculous that one has to work 80+ hours a week (more maybe so that fellow residents see you are "pulling your weight") and then do an additional 30 hours of reading/studying/preparing for presentations on my "own time". Looks like residents just sleep and work, nothing else.

Before work hour restrictions - residents in certain specialties were working 100 hour work weeks. One thing for sure is you will get absolutely NO sympathy from people who finished residency before 2003. NONE. ZERO. ZILCH.

It is perfectly ok for you to believe what you believe. What we are trying to tell you is the realities of residency training involves seeing patients, working them up, certain specialties seeing them from admit to discharge, as well as attending and setting up conferences, doing presentations, doing research, taking annual exams, etc. You're right many residents in certain specialties do nothing but sleep, study, and work. You are also free to think it's ridiculous and that's ok.

But guess what, that's a HUGE warning sign that medicine is not for you. Even if you enter a more lifestyle friendly specialty - you will have to do an internship that isn't lifestyle friendly, and before that you will do clerkships that aren't lifestyle friendly. This doesn't even include the vast studying you'll be doing from M1 onwards. The only exception I believe is Pathology in which you don't do a clinical internship. Take this as a HUGE alarm that medicine thru the physician pathway just is not for you.

 

[KnuxNole]

As a medical student, I never liked work hour restrictions, and as an intern, I freaking hate them.

Interns are mandated to only work 16 hour shifts, so there is a complicated system of night float and cross cover where there is an intern who only comes in at night and covers a lot of patients.

As a matter of fact, I'm doing the switch right now. I worked yesterday during the day, and tonight I start nights. I should probably be sleeping to let my body adjust, but I can't, so I'll feel like crap 26 hours from now when I'm in the hospital. Then I'll feel like crap when I switch back a few days from now.

And with regards to cross cover, there is nothing more terrifying that getting a stat page to a room, and walking in to a jaundiced, tachypneic patient on BiPAP and CRRT who is tachy and hypotensive. I have no idea what the hell is happening with this patient after getting my crap signout. Are they septic? Are they in liver failure? What are they post-op from? No idea. Dangerous, dangerous, dangerous.

That resident should have at least told you what the post OP is...I take 5 mins per patient on sign out...but then again I'm in a speciality where our hospital stuff has a fairly manageable size census....

 

[KnuxNole]

You prove my point.

There are people that can power through a 24 hour shift like a god. I'm not like that though, when I'm on call, after checkout, if there are no admits or pages, I get food, then relax and sleep early. Thankfully, there are nights on call I can sleep from 11-5/6(which is nice when residents properly tuck patients in without forgetting basic orders to be called about)

 

[Mr.Happy]

Before work hour restrictions - residents in certain specialties were working 100 hour work weeks. One thing for sure is you will get absolutely NO sympathy from people who finished residency before 2003. NONE. ZERO. ZILCH.

It is perfectly ok for you to believe what you believe. What we are trying to tell you is the realities of residency training involves seeing patients, working them up, certain specialties seeing them from admit to discharge, as well as attending and setting up conferences, doing presentations, doing research, taking annual exams, etc. You're right many residents in certain specialties do nothing but sleep, study, and work. You are also free to think it's ridiculous and that's ok.

But guess what, that's a HUGE warning sign that medicine is not for you. Even if you enter a more lifestyle friendly specialty - you will have to do an internship that isn't lifestyle friendly, and before that you will do clerkships that aren't lifestyle friendly. This doesn't even include the vast studying you'll be doing from M1 onwards. The only exception I believe is Pathology in which you don't do a clinical internship. Take this as a HUGE alarm that medicine thru the physician pathway just is not for you.

Just because I'm unhappy about working 110+ hours per week (when you include time for reading/studying) doesn't mean I won't do it. Heck, I would choose medicine even if attending physicians only made 40k a year or if I had to live in the hospital full-time. However, I'm just voicing my disagreement.

 

[DermViser]

Just because I'm unhappy about working 110+ hours per week (when you include time for reading/studying) doesn't mean I won't do it. Heck, I would choose medicine even if attending physicians only made 40k a year or if I had to live in the hospital full-time. However, I'm just voicing my disagreement.

You're right. You'll just be a miserable resident who will work the last nerve of other residents/attendings around you or a medical student who will work the last nerve of residents/attendings around you. Take your pick.

If you already think that 110+ hours per week (including reading/studying) is __________________ (insert adjective here: inhumane, ridiculous, etc.) It is very HIGHLY unlikely that you would be ok with being an attending who would be ok with a 40k salary per year or had to live in the hospital full time. You can lie to others, but not yourself.

Guess what as an attending -- you have NO work hour restrictions. What are you going to do then?

 

[DermViser]

Then perhaps medicine isn't for you, end of story. You have to learn. You learn by seeing patients and being in the hospital. You prepare for that learning by reading and studying. You seem to think learning can just happen magically without time investment. You would be wrong.

What's funny is that he has the idea to actually learn from what people are telling him on such a wonderful resource as SDN and instead chooses to fight it, rather than actually take it into deep consideration and act accordingly.

 

[Mr.Happy]

You're right. You'll just be a miserable resident who will work the last nerve of other residents/attendings around you or a medical student who will work the last nerve of residents/attendings around you. Take your pick.

If you already think that 110+ hours per week (including reading/studying) is __________________ (insert adjective here: inhumane, ridiculous, etc.) It is very HIGHLY unlikely that you would be ok with being an attending who would be ok with a 40k salary per year or had to live in the hospital full time. You can lie to others, but not yourself.

Guess what as an attending -- you have NO work hour restrictions. What are you going to do then?

I get your point but I'm not that kind of person. Once I resign myself to a task, then I make sure I have a positive attitude towards it and I give my best effort. I just haven't resigned myself to it yet though it looks like I will have to.

As an EM attending, I can work 36 hours a week. Just one example and I'm willing to take the pay cut.

 

[Mr.Happy]

What's funny is that he has the idea to actually learn from what people are telling him on such a wonderful resource as SDN and instead chooses to fight it, rather than actually take it into deep consideration and act accordingly.

I am taking it into deep consideration. However I'm not some sheep or brainless follower who will just quickly agree with what everyone says and not question the status quo. To say that working 110-120 hours per week (including reading/studying hours) results in a healthy and happy person would be hard for anyone to believe or accept.

 

[DermViser]

I get your point but I'm not that kind of person. Once I resign myself to a task, then I make sure I have a positive attitude towards it and I give my best effort. I just haven't resigned myself to it yet though it looks like I will have to.

As an EM attending, I can work 36 hours a week. Just one example and I'm willing to take the pay cut.

Resigning yourself to something is not the best attitude to have when approaching something like medicine. And no you don't have to resign yourself bc you haven't entered medical school yet. You're still a premed.

Also there's a reason that EM is only 36 hours a week. It's bc they do 12 hour shifts and their shifts are MUCH MUCH more exhausting due to their specific patient population and the nonstop pace of the ER. There's a reason that specialty has such a high burnout rate.

 

[DermViser]

I am taking it into deep consideration. However I'm not some sheep or brainless follower who will just quickly agree with what everyone says and not question the status quo. To say that working 110-120 hours per week (including reading/studying hours) results in a healthy and happy person would be hard for anyone to believe or accept.

You are free to "question the status quo" all you like. Medical school and residency will do a great job beating that out of you if you hope to make it out without a target on your back. The healthcare system doesn't care for you being a "health and happy" person. The purpose of the healthcare system is for patients to be treated. End of story. It definitely doesn't care for the health and happiness for the physician - esp. now with Obamacare.

If you still wish to practice medicine - but hours are a valid concern to you - then the PA or NP pathways is much more conducive to your concerns.

 

[VisionaryTics]

That resident should have at least told you what the post OP is...I take 5 mins per patient on sign out...but then again I'm in a speciality where our hospital stuff has a fairly manageable size census....

He told me small-bowel resection...I wasn't sure for what.

Yeah, 5 mins per patient would keep the day intern there for another shift.

 

[gettheleadout]

Like I said someone who knows the patient well vs someone cross covering?

Some would argue that better learning happens when you can see a pathology evolve/resolve over time. This sometimes takes longer than 16 hours.

Gross misapplication of a single poor quality study

It was a serious question. I don't know what the answer is which is why I'm asking.

Residents sleep less with an 80 hour cap. You have MORE to do because you are expected to keep up with your reading, presentations etc. on 'your own time'. Does lack of sleep affect education? Yes.

My role is a resident is to learn to be a physician. My training program is 7 years. I honestly feel, half way through, that there isn't enough time to learn everything that I need to. This is most likely not true, given the level of competency that we produce. If there is something going on, you have to kick me out of the hospital.

We work 80 hours/week. I don't know of any direct data linking long work hours and physical health. Patients are worse off with shorter shifts than with tired residents.

Who are you expecting to take care of the patients the OTHER 16 hours a day? The patients nor the work disappear just because it is 5pm. Education is part of residency. Service is the other part.

I am in appropriate shape after 26 hours in to take care of the vast majority of patients that roll in the door. No, I am not as good as in hour 6, but... Handoffs are deadly and costly. And it isn't even close. Medical training requires a LOT of hands on time. You simply can't do it 9-5 every day. People complain about scut work and paperwork. They are a part of the day for physicians. You either have to do it or hire and train someone to do it for you. At the end of the day, you need to be able to do it and do it well. And then, you need to learn how to be a physician.

There are plenty of residents that clock in, clock out. Other residents dislike them because they are dumping more work on the others and not pulling their own weight. They are also sacrificing their education. You are the sum total of your experiences. For residents, that means time in the hospital dealing with floor calls, seeing consults, being in clinic, the OR, etc. Every minute that you give up is one less minute of education.

I'm definitely not one looking to do a 9-5 residency or clock out and leave work for my colleagues. I understand that residents want experience but there has to be a midpoint that maximizes educational time and minimizes the impact of the work hours; the extremes of "working literally all the time" and "working 9-5" clearly are both bad options. What is that midpoint? I don't know. Maybe it was correctly placed at ~ 100 hours/week, but that seems intuitively unlikely to me.

Why do you think medical education or residency training gives a **** what your needs are? How in anyway does that change that patients need to be seen, admitted, consulted on, treated and discharged? Why should patient's interests be considered alone? Bc they bring in money for the hospital, that's why.

I'm not saying I think their needs are considered, but they should be. If physician needs shouldn't be considered at all, why not keep residents on call everyday? Why not require residents to pay tuition? Etc. It's important and reasonable to consider the well-being of those in a profession where the work done is not only absolutely needed but also high-risk, especially when we see that the profession is especially heavy on them as well, considering the high rates of burnout among physicians even compared to other professionals.

 

[Baron Samedi]

Pre-med afraid of resident hours is almost pathognomonic for future PA.

 

[DermViser]

I'm not saying I think their needs are considered, but they should be. If physician needs shouldn't be considered at all, why not keep residents on call everyday? Why not require residents to pay tuition? Etc. It's important and reasonable to consider the well-being of those in a profession where the work done is not only absolutely needed but also high-risk, especially when we see that the profession is especially heavy on them as well, considering the high rates of burnout among physicians even compared to other professionals.

I should have said it clearer but why should your needs be considered? The healthcare system is there to treat patients. Physicians are the ones who dispense that treatment (along with NP and PA providers). Your needs and wants are secondary to what the patient needs as far as the healthcare system is concerned. Think about it - if you were a patient with a very serious condition - would you want a resident physician who barely knows you, but received sign out, to deal with you, or the resident physician who has been tracking you this entire time and knows your story?

If physician needs shouldn't be considered at all, why not keep residents on call everyday? --- bc 80 hour work weeks prevent that. Before work hour restrictions in certain specialties it was not at all unheard of to have call q2.

Why not require residents to pay tuition? --- Dentistry does this same thing for their residencies and now it's being brought up as a real possibility by the head of the ACGME, esp. for specialties like Dermatology, Radiology, Orthopedics, etc.: http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077, since the federal govt. is not interested in paying for more residency positions.

It's important and reasonable to consider the well-being of those in a profession where the work done is not only absolutely needed but also high-risk, especially when we see that the profession is especially heavy on them as well, considering the high rates of burnout among physicians even compared to other professionals. --- My point is why should the system care, esp. about your burnout? Why is your profession more special than police officers, firefighters, EMT workers, CIA agents, pharmacists, those who work on Wall Street, etc. who have the same if not more of those characteristics?

If burnout and hours during residency are a huge and valid concern to you as a senior undergraduate student - then a) choose a specialty that has lower hours during residency or b) choose an entirely different profession. Don't apply and matriculate into a school for a certain profession and then say it should be changed.

 

[DarknightX]

I'm cringing as I read this thread. Pre-meds complaining about work hours.

If you haven't experienced residency, then your opinion is worthless.

 

[DermViser]

Pre-med afraid of resident hours is almost pathognomonic for future PA.

Except their inflated egos won't allow it.

 

[DarknightX]

I should have said it clearer but why should your needs be considered? The healthcare system is there to treat patients. Physicians are the ones who dispense that treatment (along with NP and PA providers). Your needs and wants are secondary to what the patient needs as far as the healthcare system is concerned. Think about it - if you were a patient with a very serious condition - would you want a resident physician who barely knows you, but received sign out, to deal with you, or the resident physician who has been tracking you this entire time and knows your story?

If physician needs shouldn't be considered at all, why not keep residents on call everyday? --- bc 80 hour work weeks prevent that. Before work hour restrictions in certain specialties it was not at all unheard of to have call q2.

Why not require residents to pay tuition? --- Dentistry does this same thing for their residencies and now it's being brought up as a real possibility by the head of the ACGME, esp. for specialties like Dermatology, Radiology, Orthopedics, etc.: http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077, since the federal govt. is not interested in paying for more residency positions.

It's important and reasonable to consider the well-being of those in a profession where the work done is not only absolutely needed but also high-risk, especially when we see that the profession is especially heavy on them as well, considering the high rates of burnout among physicians even compared to other professionals. --- My point is why should the system care, esp. about your burnout? Why is your profession more special than police officers, firefighters, EMT workers, CIA agents, pharmacists, those who work on Wall Street, etc. who have the same if not more of those characteristics?

If burnout and hours during residency are a huge and valid concern to you as a senior undergraduate student - then a) choose a specialty that has lower hours during residency or b) choose an entirely different profession. Don't apply and matriculate into a school for a certain profession and then say it should be changed.

Spot on. If lifestyle is your concern, go into something else.

 

[DermViser]

I'm cringing as I read this thread. Pre-meds complaining about work hours.

If you haven't experienced residency, then your opinion is worthless.

Somehow I was hoping you'd make it to this thread. Welcome!!

 

[SouthernSurgeon]

That resident should have at least told you what the post OP is...I take 5 mins per patient on sign out...but then again I'm in a speciality where our hospital stuff has a fairly manageable size census....

He told me small-bowel resection...I wasn't sure for what.

Yeah, 5 mins per patient would keep the day intern there for another shift.

5 minutes per patient is completely unrealistic. For a 20 patient census that is 100 minutes. No one has time for that. Plus you simply can't concentrate for that long on every patient, so it's still ineffective communication.

We've actually timed some of our interns doing sign out. Uncomplicated sign outs are less than 30 seconds on average, sometimes as low as <5 seconds (" 21 yo postop from lap appy, no medical history, going home tomorrow") . New admits or complicated/sick patients more like 1 minute.

 

[Baron Samedi]

Except their inflated egos won't allow it.

Well then once they go the PA route they'll tell everyone that "I could have been a doc but I wanted to have a life" while also saying that PA school is medical school on steroids.

 

[DarknightX]

I don't "seem to think" anything. I said I'm willing to to undergo a longer residency training period so that I can have more reasonable work hours.

You have no idea what you're talking about.

If I'm post call and a cool case comes in, guess whose staying in to do it? Me. No way I'm giving that case away to a junior resident on my service. I want to learn and I want to see as much as possible. There are certain rotations where I don't take days off. Not because I am forced; it's because I want to. I don't want anyone to put artificial limits on how much I can work. I had one rotation where I didn't take a day off for 2 months.

Does anyone force me to do this? No. Actually my attendings discourage it, and I've been reprimanded for such practice as it violates ACGME rules. It's my education, and the closer you get to finishing residency, the scarier it gets, especially for procedural based specialties like surgery.

If you want work limits and you're already complaining about hours, find something else to do.

 

[gettheleadout]

I should have said it clearer but why should your needs be considered? The healthcare system is there to treat patients. Physicians are the ones who dispense that treatment (along with NP and PA providers). Your needs and wants are secondary to what the patient needs as far as the healthcare system is concerned. Think about it - if you were a patient with a very serious condition - would you want a resident physician who barely knows you, but received sign out, to deal with you, or the resident physician who has been tracking you this entire time and knows your story?

The physical and psychological needs of physicians are not secondary to the medical needs of those they serve, IMO, they are connected in tandem. Ignoring that is like saying that a car's need to be serviced is secondary to your need to drive it. It sounds fine, but you end up with a car that's worse for the wear and won't be able to as reliably drive you where and when you need it to.

If physician needs shouldn't be considered at all, why not keep residents on call everyday? --- bc 80 hour work weeks prevent that. Before work hour restrictions in certain specialties it was not at all unheard of to have call q2.

Right, but I'm asking about what should be done. Do you think being on call literally every single day for 5 years is reasonable? Surely it would make residents more available to provide care to the patients who need it and are top priority in this system.

Why not require residents to pay tuition? --- Dentistry does this same thing for their residencies and now it's being brought up as a real possibility by the head of the ACGME, esp. for specialties like Dermatology, Radiology, Orthopedics, etc.: http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077, since the federal govt. is not interested in paying for more residency positions.

I'm aware, but it was supposed to be rhetorical since surely you agree that it's unreasonable considering the amount of labor and results residents deliver, governmental cheapskate nature aside.

It's important and reasonable to consider the well-being of those in a profession where the work done is not only absolutely needed but also high-risk, especially when we see that the profession is especially heavy on them as well, considering the high rates of burnout among physicians even compared to other professionals. --- My point is why should the system care, esp. about your burnout? Why is your profession more special than police officers, firefighters, EMT workers, CIA agents, pharmacists, those who work on Wall Street, etc. who have the same if not more of those characteristics?

All professions should be cognizant of the effects of things like burnout on their members. Especially so in professions where the amount of time/money/effort invested in producing a single competent member is especially great.

If burnout and hours during residency are a huge and valid concern to you as a senior undergraduate student - then a) choose a specialty that has lower hours during residency or b) choose an entirely different profession. Don't apply and matriculate into a school for a certain profession and then say it should be changed.

That's completely unfair though; I have to find a profession 100% perfect or else be a hypocrite in choosing it? People go into professions for the purpose of "reform" all the time.

 

[DermViser]

Spot on. If lifestyle is your concern, go into something else.

What is completely galling to me is that premeds are actually being given the nitty gritty from residents and attendings on how things actually are (since they asked - or at least the OP did before she erased her post) and instead of accepting it as that is what it is and making their career decisions accordingly, they wish to change it per the way they think it should be. And this is WITH an 80 hour work week restriction - which I believe a previous poster said that 40 hours/5 days per week would be much more reasonable.

If you are a premed, you are in NO WAY locked into this profession. Lift up your head for a moment from your Examkrackers book and actually fully research the journey from med school --> residency --> fellowship --> attending, before you completely dive in headfirst signing promissory notes for six figure non-dischargeable debt. Start doing ECs that actually show you what training and medicine is truly like and that you would love the positives and be fully ok with the negatives. Don't blame the medical profession bc you chose to get a lopsided view of what medicine is like based on doing weak ECs which gave you a distorted view and then wish to change the rules midway thru the game.

 

[DarknightX]

The physical and psychological needs of physicians are not secondary to the medical needs of those they serve, IMO, they are connected in tandem. Ignoring that is like saying that a car's need to be serviced is secondary to your need to drive it. It sounds fine, but you end up with a car that's worse for the wear and won't be able to as reliably drive you where and when you need it to.


Right, but I'm asking about what should be done. Do you think being on call literally every single day for 5 years is reasonable? Surely it would make residents more available to provide care to the patients who need it and are top priority in this system.


I'm aware, but it was supposed to be rhetorical since surely you agree that it's unreasonable considering the amount of labor and results residents deliver, governmental cheapskate nature aside.


All professions should be cognizant of the effects of things like burnout on their members. Especially so in professions where the amount of time/money/effort invested in producing a single competent member is especially great.


That's completely unfair though; I have to find a profession 100% perfect or else be a hypocrite in choosing it? People go into professions for the purpose of "reform" all the time.

How many hours of residency have you completed?

How can you comment on something you haven't experienced?

 

[DermViser]

How many hours of residency have you completed?

How can you comment on something you haven't experienced?

You mean his MCAT score and GPA aren't enough? He's only trying to "reform" it, after all.

 

[DarknightX]

Thank you. Fair point. I know the reality on the ground can be very different from the ideals in my mind. I just think it's ridiculous that one has to work 80+ hours a week (more maybe so that fellow residents see you are "pulling your weight") and then do an additional 30 hours of reading/studying/preparing for presentations on my "own time". Looks like residents just sleep and work, nothing else.

If you think it's ridiculous, then don't go into medicine. I can assure you that I consistently hit over 80 hours a week, and yes, none of that counts toward reading/studying/preparation.

My days usually go like this: Get in at 6 am, round with team (expect that my interns have seen all the patients on the service, usually 10-20).

Get to OR by 7:30. Operate till about 5-6. If I'm not on call, afternoon rounds till about 7. On a good day, I'm out by 7:30-8:00 on average.

Hit the gym for 30-45 minutes. Get home. Read/study for 45-60 minutes for ABSITE/boards. Then get ready for the next day's cases. This includes reading patient's H&P and reviewing what operation we are going to do. If it's an operation I haven't seen before or not comfortable with, I'll try to watch it on youtube in addition to reading about it. Usually done with everything around 11 or midnight and then go to sleep.

If I'm on call (we do Q3-Q4 call, depending on rotation), I usually stay the next day till about 10 or 11, unless there's cases, then I'm staying until cases are done. If they are cases my junior can cover (hernia, gallbladder, appy, etc), then I'll leave it to them. If it's a senior level case or something I haven't seen before, then I'm staying to do it.

Sleep and work, nothing else.....sounds just about right.

Despite all this work, I still don't feel ready to be on my own.

 

[gettheleadout]

How many hours of residency have you completed?

How can you comment on something you haven't experienced?

You mean his MCAT score and GPA aren't enough? He's only trying to "reform" it, after all.

I see this conversation will continue to be productive.

 

[DermViser]

I see this conversation will continue to be productive.

The point being made (although tongue in cheek on my part and likely @DarknightX's part) is you have no credential to question the graduate medical education system that has been place in the United States for decades. The only reason it has even changed recently (since 2003) in terms of work hours is due to the threat of Congress passing federal legislation regarding residency work hours, so the ACGME said they would change things themselves instead and self-regulate rather than have it imposed from the outside.

 

[Baron Samedi]

Not too many people within the system even complain about the hours. The belief that we are miserable because of our work schedules is largely false and comes from those with no actual experience. Working hard for a few years is better than the alternative of being an incompetent and dangerous attending.

 

[Mad Jack]

This is hilarious, just wait till your a private practice physician and work ( pager call, home call and actual hospital call) greater than 80 hrs/ week consistently! THERE IS NO FREE LUNCH.

Pretty sure you do that one to yourself. I don't know a single physician outside of the surgical subspecialties that clocks over 80 hours a week regularly as an attending because they have to. There's a few hospitalists that pick up extra hours and end up working 18-30 days straight sometimes, but that's really them doing it to themselves for the money, not because they're being forced to be their group.

 

[gettheleadout]

The point being made (although tongue in cheek on my part and likely @DarknightX's part) is you have no credential to question the graduate medical education system that has been place in the United States for decades. The only reason it has even changed recently (since 2003) in terms of work hours is due to the threat of Congress passing federal legislation regarding residency work hours, so the ACGME said they would change things themselves instead and self-regulate rather than have it imposed from the outside.

The funny thing here is when you say "question" you mean in it the sense of specific criticism, not the actual asking of questions and consideration of possible virtues and problems. The latter is what I'm actually doing, and every individual has the right to do that. However, even if I were proposing specific criticism or change, by analogy a schoolchild in the 1950's would "have no credential to question the [segregated public education system that had been in place in the US for decades.]"

Despite the discussion we've had, I'm fairly certain neither of you can even state for me what my view on the current system is, and so your aversion to my questioning implies that you're simply assuming I'm making arrogant judgments about what should or should not be changed.

 

[Baron Samedi]

Woah strong race card play. Didn't even see it coming!!

 

[VisionaryTics]

The funny thing here is when you say "question" you mean in it the sense of specific criticism, not the actual asking of questions and consideration of possible virtues and problems. The latter is what I'm actually doing, and every individual has the right to do that. However, even if I were proposing specific criticism or change, by analogy a schoolchild in the 1950's would "have no credential to question the [segregated public education system that had been in place in the US for decades.]"

Despite the discussion we've had, I'm fairly certain neither of you can even state for me what my view on the current system is, and so your aversion to my questioning implies that you're simply assuming I'm making arrogant judgments about what should or should not be changed.

Oh, dear Lord...

 

[KnuxNole]

Darkknight, on the flip side, there are residents who would punt cases to the person on call so they can go home. As you and I know both know, sadly not everyone cares about education. While I would not punt cases and miss out, I know there are people who do that, in addition to people who never read outside of the hospital...I remember someone asked why I was reading when I was already done with step 3 and boards are a while away. I mean, I'm sure some can learn on the job, but I can't....

 

[DermViser]

The funny thing here is when you say "question" you mean in it the sense of specific criticism, not the actual asking of questions and consideration of possible virtues and problems. The latter is what I'm actually doing, and every individual has the right to do that. However, even if I were proposing specific criticism or change, by analogy a schoolchild in the 1950's would "have no credential to question the [segregated public education system that had been in place in the US for decades.]"

Despite the discussion we've had, I'm fairly certain neither of you can even state for me what my view on the current system is, and so your aversion to my questioning implies that you're simply assuming I'm making arrogant judgments about what should or should not be changed.

Do you actually think that the "asking of questions and consideration of possible virtues and problems" that you have come up with haven't been considered and thought of by others way ahead of you and with much more qualifications and experience to remark on GME?

You're really going to make an analogy between resident work hours and racial segregation in public schools? Really? In the latter case, the federal govt. stepped in when change wasn't coming on the inside.

Your actual view on the current system is irrelevant (and honestly, I don't think DarknightX cares). We're going based off what you've stated so far in this thread that somehow the healthcare system whose purpose is to fully take care of patients needs in this country should somehow also take into account a physician's (or any other health care provider's) needs. And yes, based on what you've laid out so far, you are in fact making arrogant judgements on what should or should not be changed bc you have absolutely no experience in which to base this on.